Sjögren’s Syndrome (SS) is a chronic autoimmune disorder where the body’s immune system mistakenly attacks healthy cells, primarily those that produce moisture, leading to the characteristic dryness of the eyes and mouth. SS is a systemic disease that can affect multiple organ systems, including the nervous system and the inner ear. Sjögren’s Syndrome can definitively cause vertigo, as its systemic nature is linked to neurological and vestibular complications that directly impact balance and spatial orientation. Patients with SS may experience a range of balance issues, from mild unsteadiness to severe spinning sensations.
The Connection Between Sjögren’s and Balance Issues
Balance problems, dizziness, and vertigo are recognized as extra-glandular manifestations of Sjögren’s Syndrome, meaning they occur outside the salivary and lacrimal glands. These symptoms often go underreported or are misattributed to other causes, but recent studies show a measurable link between SS and vestibular dysfunction. Patients with SS have a statistically higher prevalence of vertigo compared to the general population, with one study finding the rate to be around 4.6% versus 3.2% in matched controls, suggesting a clear association.
The patient experience varies significantly, ranging from general disequilibrium (unsteadiness or imbalance) to true rotational vertigo, the illusion of spinning or moving. Disequilibrium is often described as a floating or swimming sensation. True vertigo is a more intense spinning sensation resulting from an asymmetric signal generated within the vestibular system.
Other related symptoms include chronic dizziness and lightheadedness, sometimes linked to autonomic nervous system involvement in SS. This range of symptoms can severely affect mobility and increase the risk of falls. Recognizing these balance issues as part of the disease spectrum is important for proper diagnosis and effective management.
Mechanisms of Vestibular System Damage in Sjögren’s
Sjögren’s Syndrome causes vestibular dysfunction through multiple biological mechanisms affecting both the peripheral and central nervous systems. One primary mechanism involves Autoimmune Inner Ear Disease (AIED), where the immune system directly attacks the delicate structures of the inner ear. This autoimmune attack leads to inflammation and subsequent damage to the cochlea and the vestibular labyrinth.
Another related mechanism is vasculitis, the inflammation of blood vessel walls. In SS, this can involve the small blood vessels supplying the inner ear structures, restricting necessary blood flow and oxygen. This reduced blood supply damages the sensory hair cells and neurons responsible for detecting movement and maintaining balance, leading to vertigo and disequilibrium. Sensorineural hearing loss frequently co-occurs with vestibular symptoms.
Sjögren’s Syndrome also causes peripheral neuropathy, which affects the vestibular nerve (Cranial Nerve VIII) that transmits balance signals from the inner ear to the brain. This nerve damage disrupts the communication pathway, causing inaccurate signals that result in dizziness and imbalance. SS can also affect the central nervous system (CNS), sometimes mimicking other neurological disorders like multiple sclerosis.
CNS involvement leads to vertigo by directly affecting the brain regions responsible for processing balance and spatial orientation. These regions include the vestibular nuclei in the brainstem and the cerebellum, which integrates balance information from the eyes, inner ear, and body. The underlying autoimmune process of SS drives the impaired vestibular function, whether the damage is peripheral or central.
Clinical Evaluation and Management of Vertigo
When a patient with Sjögren’s Syndrome presents with vertigo or dizziness, the clinical evaluation focuses on pinpointing the specific location and cause of the vestibular impairment. Diagnostic tools assess the function of the inner ear and the balance pathways in the brain. Audiometry is often performed to check for co-occurring sensorineural hearing loss, which frequently accompanies vestibular damage.
Specialized Vestibular Function Tests (VFTs) are essential, including the video Head Impulse Test (vHIT) and Vestibular Evoked Myogenic Potentials (VEMPs). The vHIT measures the vestibulo-ocular reflex (VOR) to determine the health of the semicircular canals and the vestibular nerve. VEMPs assess the function of the saccule and utricle, the inner ear organs that detect linear acceleration and gravity. Abnormal results, such as reduced VOR gain, suggest vestibular involvement linked to SS.
Management of Sjögren’s-related vertigo is two-pronged: treating the underlying autoimmune disease and managing the symptoms. If the cause is inflammatory (e.g., AIED or vasculitis), the rheumatologist may prescribe immunomodulatory therapy, including corticosteroids or other immunosuppressants, to reduce the immune response. This treatment aims to halt the autoimmune attack damaging the vestibular system.
For chronic balance issues and persistent dizziness, patients may be referred to Vestibular Rehabilitation Therapy (VRT). VRT is a specialized physical therapy that helps the brain compensate for impaired inner ear function through specific exercises. In acute episodes of severe vertigo, short-term use of vestibular suppressant medications may alleviate the intense spinning sensation, though these are not a long-term solution.